In-hospital Mortality In Elderly Patients Research Articles

In-Hospital Mortality following Proximal Femur Fractures in Elderly Population.

Context In India, hip fracture crude incidence above the age of 50 years was 129 per 100,000. Aims The aim of this study is to analyze the in-hospital mortality following proximal femur fractures in elderly Indian population. Methods and Material The study was done in Sri Ramachandra Medical Center, Chennai, India. Patient's records were retrospectively evaluated for a period of 3 years from January 1, 2015 to January 1, 2018. The inclusion criteria were patients both male and female aged more than 65 years admitted with the diagnosis of neck of femur or intertrochanteric or subtrochanteric fractures. The exclusion criteria were patients having any associated fracture or previous hip fracture history or diagnosed primary or secondary malignancies. To evaluate any surgical delay two groups were formed. After eliminating cases based on exclusion criteria, we had 270 patients for evaluation. Statistical Analysis Used The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean and standard deviation (SD) were used for continuous variables. To find the significant difference between the bivariate samples, Student's t -test and analysis of variance (ANOVA) were used. The p -value of 0.05 is considered as significant level. Results We had a total of 24 mortalities with 15 males and 9 females. The in-hospital mortality of patients who underwent replacement surgeries for proximal femur fractures was 14 in our study. Sixteen of the in-hospital mortality patients had low Parker's mobility score. Twenty patients had mortality when surgery was delayed more than 48 hours. Conclusions In-hospital mortality in elderly patients having proximal femur fracture increases significantly if the patient was having low-preoperative mobility status, if surgery was delayed more than 48 hours, and if patient undergoes replacement surgeries.

Abbreviated National Early Warning Score predicts the need for hospital admission and in-hospital mortality in elderly patients

The aim of this study was to evaluate the value of the Abbreviated National Early Warning Score (aNEWS) for predicting admissions and in-hospital mortality in elderly patients present to Emergency Department (ED). This retrospective, single-centred observational study was carried out in the ED of Minamitama Hospital, in Tokyo, Japan from 1 April 2018 to 30 April 2018. All of the patients aged 65 and older were included in this study. The aNEWS is based on six common physiological vital signs, including peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate, and the Alert, responds to Voice, responds to Pain, Unresponsive score. The scores range from 0 and 3 for each parameter. The aNEWS ranged from a score of 0 to a maximum of 17. The receiver operating characteristics (ROC) analysis was used to evaluate the predictive value of the aNEWS for admission and in-hospital mortality. The median aNEWS of patients admitted to the hospital was significantly higher than that of patients discharged from the ED (P<0.001). The median aNEWS of survivors was significantly higher than that of non-survivors (P<0.001). The Areas under the ROC Curve (AUC) for predicting admission was 0.773 [95% CI 0.7142 to 0.8317, P<0.001] for the aNEWS. The AUC for predicting in-hospital mortality was 0.791 [95% CI 0.604 to 0.978, P<0.001] for the aNEWS. Our single-centred study has demonstrated the utility of the aNEWS as a predictor of patient admission and in-hospital mortality in elderly patients.

Adequacy of antithrombotic treatment, characteristics and inhospital mortality of elderly patients with non-valvular atrial fibrillation: results of the NONAVASC registry.

Adequacy of antithrombotic treatment, characteristics and inhospital mortality of elderly patients with non-valvular atrial fibrillation: results of the NONAVASC registry.

Prognostic Value of Neutrophil to Lymphocyte Ratio for In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction.

Coronary artery disease (CAD) is a multifactorial disease in which inflammation plays a central role. This study aimed to investigate the association of inflammatory markers such as the neutrophil to lymphocyte ratio (NLR), the Global Registry of Acute Coronary Events (GRACE) score with in-hospital mortality of elderly patients with acute myocardial infarction (AMI) in an attempt to explore the prognostic value of these indices for elderly AMI patients. One thousand consecutive CAD patients were divided into two groups based on age 60. The laboratory and clinical characteristics were assessed retrospectively by reviewing the medical records. The NLR and GRACE score were calculated. In the elderly (≥60 years), patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) had significantly higher NLR than did those with unstable angina (UA) and stable angina pectoris (SAP) (P<0.01). The NLR was considerably elevated in older AMI patients compared with their younger counterparts (<60 years) (P<0.05). In elderly AMI patients, the NLR was considerably higher in the high-risk group than in both the low-risk and medium-risk groups based on the GRACE score (P<0.05 and P<0.01, respectively), and the NLR was positively correlated with the GRACE score (r=0.322, P<0.001). Either the NLR level or the GRACE score was significantly higher in the death group than in the surviving group (P<0.05). By curve receiver operator characteristic curve (ROC) analysis, the optimal cut-off levels of 9.41 for NLR and 174 for GRACE score predicted in-hospital death [ROC area under the curve (AUC) 0.771 and 0.787, respectively, P<0.001]. It was concluded that an elevated NLR is a potential predictor of in-hospital mortality in elderly patients with AMI.

Delay in time from fracture to surgery: A potential risk factor for in-hospital mortality in elderly patients with hip fractures

PurposeTo estimate the Impact of delay in surgery for elderly hip fractures on short term outcome measured in terms of in-hospital mortality. MethodsRetrospective study involving patients above 60 years of age with a primary diagnosis of hip fracture treated by surgery to analyze the relation between timing of surgery and in-hospital mortality. ResultsThere were 144 patients who met the criteria. Delayed surgery more than 48 h was associated with higher in-hospital mortality risk. (OR:8.3, 95% CI 1.04–66.64, p = 0.01). ConclusionsDelay in hip fracture surgery increases in-hospital mortality risk.

Performance status and in-hospital mortality of elderly patients with community acquired pneumonia

To evaluate the role of performance status evaluated by the Eastern Cooperative Oncology Group (ECOG) score in predicting 30-day mortality in subjects hospitalized for community acquired pneumonia (CAP), this was a prospective study of patients consecutively hospitalized for CAP at a large University Hospital in Italy. Performance status was evaluated using the ECOG score that in a 0-5 point scale indicates progressive functional deterioration. The end-point of the study is the 30-day mortality. Two-hundred-sixteen patients were enrolled, 75.9% were aged > 70years, 31.5% had severe pneumonia at CURB-65 score (3-4), and 27.5% of patients had severe disability (ECOG 3-4). Thirty-day mortality is 15.3%. Progression in ECOG score independently increases the probability of 30-day mortality at multivariable logistic regression analysis (HR 2.19, 95% CI 1.60-3.01, p < 0.0001). ECOG 3 or 4 determines a four-fold increase in 30-day mortality (HR 4.07, 95% CI 1.84-9.02, p < 0.001). ECOG score 3 or 4 is highly predictive of death in patients classified at low risk of mortality by CURB-65 (0-2 points) score. Functional status is directly related to outcome in elderly patients hospitalized for CAP. The use of a very simple and fast tool, such as the ECOG score, might help to better stratify the risk of short-term mortality, especially in patients otherwise classified at low risk of death by CURB-65 score.

Red blood cell distribution width is associated with mortality in elderly patients with sepsis

IntroductionRDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients. MethodsThis was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015. Elderly patients (≥65years old) who were admitted to the ED-ICU with a diagnosis of severe sepsis and/or septic shock were included. The demographic data, biochemistry data, qSOFA, and APACHE II score were compared between survivors and nonsurvivors. ResultsA total of 117 patients was included with mean age 81.5±8.3years old. The mean APACHE II score was 21.9±7.1. In the multivariate Cox proportional hazards model, RDW level was an independent variable for mortality (hazard ratio: 1.18 [1.03–1.35] for each 1% increase in RDW, p=0.019), after adjusting for CCI, any diagnosed malignancy, and eGFR. The AUC of RDW in predicting mortality was 0.63 (95% confidence interval [CI]: 0.52–0.74, p=0.025). In subgroup analysis, for qSOFA <2, nonsurvivors had higher RDW levels than survivors (17.0±3.3 vs. 15.3±1.4%, p=0.044). ConclusionsIn our study, RDW was an independent predictor of in-hospital mortality in elderly patients with sepsis. For qSOFA scores <2, higher RDW levels were associated with poor prognosis. RDW could be a potential parameter used alongside the clinical prediction rules.

Prediction model of in-hospital mortality in elderly patients with acute heart failure based on retrospective study.

ObjectivesThe aim of this study was to develop a clinical risk model that is predictive of in-hospital mortality in elderly patients hospitalized with acute heart failure (AHF).Methods2486 patients who were 60 years and older from intensive care units of Cardiology Department in the hospital were analyzed. Independent risk factors for in-hospital mortality were obtained by binary logistic regression and then used to establish the risk prediction score system (RPSS). The area under the curve (AUC) of receiver operator characteristic and C-statistic test were adopted to assess the performance of RPSS and to compare with previous get with the guidelines–heart failure (GWTG-HF).ResultsBy binary logistic regression analysis, heart rate (OR: 1.043, 95% CI: 1.030–1.057, P < 0.001), left ventricular ejection fraction (OR: 0.918, 95% CI: 0.833–0.966, P < 0.001), pH value (OR: 0.001, 95% CI: 0.000–0.002, P < 0.001), renal dysfunction (OR: 0.120, 95% CI: 0.066–0.220, P < 0.001) and NT-pro BNP (OR: 3.463, 95% CI: 1.870–6.413, P < 0.001) were independent risk factors of in-hospital mortality for elderly AHF patients. Additionally, RPSS, which was composed of all the above-mentioned parameters, provided a better risk prediction than GWTG-THF (AUC: 0.873 vs. 0.818, P = 0.016).ConclusionsOur risk prediction model, RPSS, provided a good prediction for in-hospital mortality in elderly patients with AHF.

Baseline functional status as the strongest predictor of in-hospital mortality in elderly patients with non-valvular atrial fibrillation: Results of the NONAVASC registry

ObjectivesAtrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. MethodsObservational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. ResultsWe evaluated 804 patients with a mean age of 85±5.1years, of which 53.9% were females. During the hospitalization 10.1% (n=81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32–9.63), and admissions for stroke (OR 3.55, 95% CI 1.41–8.90) and acute renal failure (OR 1.93, 95% CI 1.12–3.32). ConclusionThe overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population.

Decreasing skeletal muscle as a risk factor for mortality in elderly patients with sepsis: a retrospective cohort study

BackgroundOlder patients account for the majority of patients with sepsis. The objective of this study was to determine if decreased skeletal muscle mass is associated with outcomes in elderly patients with sepsis.MethodsPatients (60 years and older) who were admitted to a tertiary medical center intensive care unit with a primary diagnosis of sepsis between January 2012 and February 2016 were included. Patients who had not undergone abdominal computed tomography on the day of admission, had cardiopulmonary arrest on arrival, or had iliopsoas abscess were excluded from the analyses. Cross-sectional muscle area at the 3rd lumber vertebra was quantified, and the relation to in-hospital mortality was analyzed. Multivariable logistic regression analysis that included sex and APACHE II score as explanatory variables was performed. The optimal cutoff value to define decreased muscle mass (sarcopenia) was calculated using receiver operating characteristic curve analysis, and the odds ratio for in-hospital mortality was determined.ResultsThere were 150 elderly patients with sepsis (median age, 75 years) enrolled; in-hospital mortality and median APACHE II score were 38.7 and 24%, respectively. The skeletal muscle area of deceased patients was significantly lower than that of the survival group (P < 0.001). The multivariable logistic regression analysis demonstrated that decreased muscle mass was significantly associated with increased mortality (odds ratio = 0.94, 95% confidence interval = 0.90 to 0.97, P < 0.001). The optimal cutoff value of skeletal muscle area to predict in-hospital mortality was 45.2 cm2 for men and 39.0 cm2 for women. With these cutoff values, the adjusted odds ratio for decreased muscle area was 3.27 (95% CI, 1.61 to 6.63, P = 0.001).ConclusionsLess skeletal muscle mass is associated with higher in-hospital mortality in elderly patients with sepsis. The results of this study suggest that identifying patients with low muscularity contributes to better stratification in this population.

Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall.

Falls are a significant cause of mortality in the elderly patients. Despite this, the literature on in-hospital mortality related to elderly falls remains sparse. Our study aims to determine the risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. All elderly case records with fall-related injuries between 2003 and 2013 were retrospectively analyzed for demographic characteristics, injury severities, comorbidity factors and clinical outcomes. Logistic regression analysis was used to examine the risk factors associated with in-hospital mortality. In total, 1026 elderly patients with fall-related injuries were included in the study. The average age of patients was 80.94±8.16years. Seventy seven percent of the patients had at least one comorbid condition. Majority of the falls occurred at home. More than half of the patients fell from ground level. Overall, the in-hospital mortality rate was 16%. Head injury constituted the most common injury sustained in patients who died (77%). In addition to age, ISS, GCS, ICU admission and anemia were significantly (P<0.05) associated with in-hospital deaths in elderly fall patients. Ground-level falls in the elderly can be devastating and carry a significant mortality rate. Elderly patients with anemia were two times more likely to die in the hospital after sustaining a fall in our study population. Increased focus on anemia which is often underappreciated in elderly fall patients can be beneficial in improving outcomes and reducing in-hospital mortality.

Lower Body Mass Index is a Risk Factor for In-Hospital Mortality of Elderly Japanese Patients Treated with Ampicillin/sulbactam.

Objectives: A retrospective examination was conducted to identify risk factors for in-hospital mortality of elderly patients (65 years or older) treated with the beta-lactam/beta-lactamase inhibitor combination antibiotic, ampicillin/sulbactam (ABPC/SBT).Methods: Clinical data from 96 patients who were hospitalized with infectious diseases and treated with ABPC/SBT (9 g/day or 12 g/day) were analyzed. Risk factors examined included demographic and clinical laboratory parameters. Parameter values prior to treatment and changes after treatment were compared between survivors and non-survivors.Results: The study patients had an average age of 81.9±8.4 years (±SD) and body mass index (BMI) of 19.9±4.2 kg/m2. They were characterized by anemia (low hemoglobin and hematocrit levels), inflammation (high leukocyte count, neutrophil count, C-reactive protein level, and body temperature), and hepatic and renal dysfunction (high aspartate aminotransferase, alanine aminotransferase and blood urea nitrogen levels). The BMI of non-survivors, 16.2±2.9 kg/m2, was lower than that of survivors, 20.4±4.1 kg/m2. In addition, the hematological parameters deteriorated more remarkably, inflammation markers were not altered (or the decrease was marginal), and hepatic function was not improved, in non-survivors.Conclusions: A lower BMI value is a risk factor for in-hospital mortality of elderly patients treated with ABPC/SBT.

Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan.

Background and objectiveThe prevalence and mortality of chronic obstructive pulmonary disease (COPD) in elderly patients are increasing worldwide. Low body mass index (BMI) is a well-known prognostic factor for COPD. However, the obesity paradox in elderly patients with COPD has not been well elucidated. We investigated the association between BMI and in-hospital mortality in elderly COPD patients.MethodsUsing the Diagnosis Procedure Combination database in Japan, we retrospectively collected data for elderly patients (>65 years) with COPD who were hospitalized between July 2010 and March 2013. We performed multivariable logistic regression analysis to compare all-cause in-hospital mortality between patients with BMI of <18.5 kg/m2 (underweight), 18.5–22.9 kg/m2 (low–normal weight), 23.0–24.9 kg/m2 (high–normal weight), 25.0–29.9 kg/m2 (overweight), and ≥30.0 kg/m2 (obesity) with adjustment for patient backgrounds.ResultsIn all, 263,940 eligible patients were identified. In-hospital mortality was 14.3%, 7.3%, 4.9%, 4.3%, and 4.4%, respectively, in underweight, low–normal weight, high–normal weight, overweight, and obese patients. Underweight patients had a significantly higher mortality than low–normal weight patients (odds ratio [OR]: 1.55, 95% confidence interval [CI]: 1.48–1.63), whereas lower mortality was associated with high–normal weight (OR: 0.76, CI: 0.70–0.82), overweight (OR: 0.73, CI: 0.66–0.80), and obesity (OR: 0.67, CI: 0.52–0.86). Higher mortality was significantly associated with older age, male sex, more severe dyspnea, lower level of consciousness, and lower activities of daily living.ConclusionOverweight and obese patients had a lower mortality than low–normal weight patients, which supports the obesity paradox.

Predicting In-Hospital Mortality in Elderly Patients with Cervical Spine Fractures: A Comparison of the Charlson and Elixhauser Comorbidity Measures

Study design Retrospective analysis of nationally representative data collected for the National Hospital Discharge Survey. Objective To compare the performance of the Charlson and Elixhauser comorbidity-based measures for predicting in-hospital mortality after cervical spine fractures. Summary of background data Mortality occurring as a consequence of cervical spine fractures is very high in the elderly. The Charlson comorbidity measure has been associated with an increased risk of mortality, but its predictive accuracy has yet to be compared with the more recent and increasingly used Elixhauser measure. Methods Using the National Hospital Discharge Survey for the years 1990 through 2007, we identified all patients aged 65 years or older hospitalized with a diagnosis of cervical spine fracture. The association of each Charlson and Elixhauser comorbidity with mortality was assessed in bivariate analysis using χ tests. Two main multivariable logistic regression models were constructed, with in-hospital mortality as the dependent variable and 1 of the 2 comorbidity-based measures (as well as age, sex, and year of admission) as independent variables. A base model that included only age, sex, and year of admission was also evaluated. The discriminative ability of the models was quantified using the area under the receiver operating characteristic curve (AUC). Results Among an estimated 111,564 patients admitted for cervical spine fractures, 7.6% died in the hospital. Elixhauser comorbidity adjustment provided better prediction of in-hospital case mortality (AUC = 0.852, 95% confidence interval: 0.848-0.856) than the Charlson model (AUC = 0.823, 95% confidence interval: 0.819-0.828) and the base model with no comorbidities (AUC = 0.785, 95% confidence interval: 0.781-0.790). In terms of relative improvement in predictive ability, the Elixhauser model performed 43% better than the Charlson model. Conclusion The Elixhauser comorbidity risk adjustment method performed numerically better than the widely used Charlson measure in predicting in-hospital mortality after cervical spine fractures. Level of evidence N/A.

Early identification of severe community-onset pneumonia in “frail elderly patient”

The article from Pieralli et al. [1], published in this issue of Internal and Emergency Medicine, underscores the importance of delirium, for the high prevalence and association with mortality, in elderly patients with communityacquired pneumonia (CAP). Despite advances in diagnosis, antimicrobial therapy and medical technologies, CAP remains an important cause of morbidity and mortality, especially in patients who require hospitalization. Approximately 1 in 20 persons over 85 years of age will present a new episode of pneumonia every year, and the incidence is likely to increase in relation to the progressive aging of the general population. In the past decade, the number of hospitalizations due to pneumonia has increased by 34 %, and this increase is primarily seen in people over the age of 75 years, who represent the population of patients with the highest risk of death. Particular attention has recently been directed at the concept of the ‘‘frail elderly patient’’ [2]. Although frailty has been considered synonymous with disability, comorbidity or advanced old age, it has only recently been recognized as a biological syndrome of decreased reserve and resistance to stressors resulting from a cumulative decline across multiple physiologic systems, and causing increased vulnerability to an adverse outcome. Fried et al. [3] developed and validated a phenotype of frailty analyzing a population of 5,317 patients aged 65 years and older. They define frailty as a clinical condition characterized by three or more of the following criteria: unintentional weight loss (10 lbs in the past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. Elderly patients with poor functional status are characterized by a higher risk of developing severe CAP, due to the frequent presence of underlying respiratory and cardiac diseases, alteration of mental status, and immunosuppression; the contemporary presence of renal impairment or hepatic failure. They usually require specific dose adjustment of antibiotic therapy, which may be toxic in this specific patient population. Moreover, older frail patients have a high frequency of aspiration pneumonia and pneumonia due to gram-negative bacilli and other multi-drug resistant (MDR) pathogens. Data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. Hence, the article of Pieralli and coworkers represents an important step forward in the assessment of the importance of delirium as a predictor of in-hospital mortality in elderly patients with CAP. In this study, delirium was highly prevalent (25 % of patients with CAP) during hospitalization and occurred more frequently in patients with an adverse outcome: the occurrence of at least one episode of delirium during the stay increased by 5.7 times the risk of in-hospital death. As reported in Table 1, pneumonia in the elderly patients tends to occur more often with extrapulmonary manifestations than with pulmonary findings: nausea, vomiting, altered sensorium or diarrhea are often present. As reported by Pieralli et al., clinical manifestations of pneumonia, such as fever, cough and self-reporting dyspnea, may frequently be absent. These diagnostic difficulties are further burdened by the fact that the white blood cell count may be within normal limits, and often fever may be absent in this group of patients due to a The commentary refers to the article available at doi:10.1007/s11739-013-0991-1

Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia

Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. The aim of this study was to evaluate predictors of in-hospital outcome in elderly patients hospitalized for CAP. In this retrospective study, consecutive patients with CAP aged ≥65 years were enrolled between January 2011 and June 2012 in two general wards. Clinical and laboratory characteristics were collected from electronic medical records. The end-point of the study was the occurrence of in-hospital death. 443 patients (mean age 81.8 ± 7.5, range 65-99 years) were enrolled. More than 3 comorbidities were present in 31 % of patients. Mean confusion, blood urea nitrogen, respiratory rate, blood pressure and age ≥65 years (CURB-65) score was 2.5 ± 0.7 points. Mean length of stay was 7.6 ± 5.7 days. In-hospital death occurred in 54 patients (12.2 %). At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p < 0.0001), and CURB-65 score (OR 3.98, p < 0.0001). Several predictors of in-hospital death (COPD, male gender, CURB-65) in patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.

Norton Scale, Hospitalization Length, Complications, and Mortality in Elderly Patients Admitted to Internal Medicine Departments

Background: The Norton scale is used for assessing pressure ulcer risk. The association between admission Norton scale scores (ANSS), hospitalization length, complications, and mortality in elderly patients admitted to internal medicine departments has never been studied. Objective: To determine if ANSS are associated with hospitalization length, complications, in-hospital mortality, and 1-year mortality in elderly patients admitted to an internal medicine department. Methods: Medical charts of consecutive elderly (≥65 years) patients admitted to a single internal medicine department between January and March 2009 were studied for ANSS, demographics, comorbidities, hospitalization length, complications during hospitalization, in-hospital mortality, and 1-year mortality. Complications during hospitalization included acute coronary syndrome, major arrhythmias, major bleeding, stroke, systemic infections, organ failure, thromboembolism, etc. ANSS ≤14 were considered low. Results: The final cohort included 259 elderly patients: 54.4% were women, the mean age was 81.6 years, and the mean hospitalization length was 3.7 days. Overall, 7.3% of the patients had complications other than pressure ulcers, 3.9% died during hospitalization, and 28.6% died within 1 year. The mean ANSS was 15.4, and 37.8% of the patients had low ANSS. Patients with low ANSS had longer hospitalization (4.7 vs. 2.9 days; p = 0.002), a higher incidence of complications during hospitalization (odds ratio: 3.9; p = 0.006), and higher rates of in-hospital mortality (odds ratio: 7.0; p = 0.007) relative to patients with high ANSS. Regression analysis showed that ANSS were independently negatively associated with hospitalization length, complications during hospitalization, and in-hospital mortality (p < 0.0001, p = 0.003, and p = 0.018, respectively) regardless of age, gender, comorbidities, and pressure ulcer appearance. Rates of 1-year mortality were similar in patients with low and high ANSS. Conclusions: The Norton scale may be used for predicting hospitalization length, complications during hospitalization other than pressure ulcers, and in-hospital mortality in elderly patients admitted to an internal medicine department.

Comparison of Functional Recovery Following Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in Three Age Groups (

Functional outcomes of elderly patients ≥80 years who undergo percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) are unknown. Registry data indicate that up to 55% of elderly patients with STEMI do not receive reperfusion therapy despite a suggested mortality benefit, and only limited data are available regarding outcomes in elderly patients treated with primary PCI. Therefore, prospective data from a regional STEMI transfer program were analyzed to determine major adverse cardiac events, length of stay, and discharge status of consecutive patients with STEMI ≥80 years from March 2003 to November 2006. Of the 1,323 consecutive patients with STEMI treated in this regional STEMI system from March 2003 to November 2006, 199 (15.0%) were ≥80 years old. In-hospital mortality in elderly patients was 11.6%, with a 1-year mortality rate of 25.6%. Of the 166 patients with age ≥80 who lived independently or in assisted living before hospital admission and survived, 150 (90.4%) were discharged to a similar living situation or projected to such a living situation after temporary nursing home care. The median length of hospital stay was 4 days for these patients. In conclusion, elderly patients with age ≥80 receiving PCI for STEMI in a regional STEMI program have short hospital stays and excellent functional recovery on the basis of a very high rate of return to a similar previous living situation.

Association between hospital volume and outcomes of elderly and non‐elderly patients with acute biliary diseases: A national administrative database analysis

This study aimed to investigate the relationship between hospital volume and clinical outcomes of elderly and non-elderly patients with acute biliary diseases using data from a national administrative database. Overall, 26720 elderly and 33774 non-elderly patients with acute biliary diseases were referred to 820 hospitals in Japan. Hospital volume was categorized into three groups based on the case numbers during the study period: low-volume, medium-volume and high-volume. We compared the risk-adjusted length of stay (LOS) and in-hospital mortality in relation to hospital volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases. Multiple linear regression analyses showed that increased hospital volume was significantly associated with shorter LOS in both elderly and non-elderly patients with and without invasive treatments. Increased hospital volume was significantly associated with decreased relative risk of in-hospital mortality in elderly patients. The odds ratio for high-volume hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533-0.847, P=0.001) and 0.715 in those with invasive treatments (95% C, 0.566-0.904, P=0.005). However, no significant differences for in-hospital mortality were seen in non-elderly patients with and without invasive treatments. This study has highlighted that higher volume hospitals significantly reduced LOS and in-hospital mortality for elderly patients with acute biliary diseases, but not non-elderly patients. The current results are of value for elderly healthcare policy decision-making, and highlight the need for further studies into the quality of care for elderly patients.

Improving in-hospital mortality in elderly patients after acute coronary syndrome—A nationwide analysis of 97,220 patients in Taiwan during 2004–2008

BackgroundElderly patients seem to have especially poor outcomes after acquiring acute coronary syndrome (ACS). We conducted this study to examine the in-hospital mortality by utilization of invasive coronary therapies and age in a nationwide population in Taiwan. MethodsThis observational study was conducted on a retrospective cohort from January 2004 to December 2008.Epidemiological features, including incidence rate and clinical characteristics of ACS in a Chinese population were investigated. Risk factors of in-hospital mortality, including myocardial infarction, shock, previous history of stroke, chronic kidney disease, diabetes mellitus, congestive heart failure, pneumonia, chronic obstructive pulmonary disease, dementia, peripheral arterial occlusive disease, septicemia and the use of invasive coronary procedures, were explored using a logistic regression model. ResultsA total of 97,220 patients were enrolled, and 53.6% of them were elderly. A significant decrease in the utilization rate of invasive coronary therapies (diagnostic coronary angiography and PCI) and increased in-hospital mortality (p<0.001) were observed as patient age increased. Adjusted multivariate logistic regression analysis revealed that the impact of PCI in reducing in-hospital mortality is consistent across age groups, including those older than 75years old. ConclusionsOur nationwide study provides evidence that PCI is associated with significant improvement of in-hospital mortality in patients with ACS. Even the very elderly patients could benefit from PCI. However, currently the utilization rate of PCI in the aging population still does not present enough. A prospective study is indicated to corroborate the findings of this study.